title: Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis.
abstract: OBJECTIVE
  The objectives of this review were to identify factors that influence implementation of hospital accreditation programmes and to assess the impact of the accreditation process on quality improvement in public hospitals.
  
  
  METHODS
  Two electronic databases, Medline (OvidSP) and PubMed, were systematically searched.
  
  
  METHODS
  "Public hospital", "hospital accreditation", and "quality improvement" were used as the search terms. A total of 348 citations were initially identified. After critical appraisal and study selection, 26 articles were included in the review.
  
  
  METHODS
  The data were extracted and analysed using a SWOT (strengths, weaknesses, opportunities, threats) analysis.
  
  
  RESULTS
  Increased staff engagement and communication, multidisciplinary team building, positive changes in organisational culture, and enhanced leadership and staff awareness of continuous quality improvement were identified as strengths. Weaknesses included organisational resistance to change, increased staff workload, lack of awareness about continuous quality improvement, insufficient staff training and support for continuous quality improvement, lack of applicable accreditation standards for local use, and lack of performance outcome measures. Opportunities included identification of improvement areas, enhanced patient safety, additional funding, public recognition, and market advantage. Threats included opportunistic behaviours, funding cuts, lack of incentives for participation, and a regulatory approach to mandatory participation.
  
  
  CONCLUSIONS
  By relating the findings to the operational issues of accreditation, this review discussed the implications for successful implementation and how accreditation may drive quality improvement. These findings have implications for various stakeholders (government, the public, patients and health care providers), when it comes to embarking on accreditation exercises.
authors.affiliation: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: G K B
authors.initials: GK
authors.lastname: Ng
authors.forename: G K K
authors.initials: GK
authors.lastname: Leung
authors.forename: J M
authors.initials: JM
authors.lastname: Johnston
authors.forename: B J
authors.initials: BJ
authors.lastname: Cowling
mesh_terms: D000068:Accreditation / Q000458:organization & administration*; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration; D017749:Total Quality Management / Q000458:organization & administration
keywords: Accreditation; Hospitals, public; Quality improvement